{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:50:07Z","timestamp":1768783807555,"version":"3.49.0"},"reference-count":42,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2022,2,11]],"date-time":"2022-02-11T00:00:00Z","timestamp":1644537600000},"content-version":"unspecified","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Veterans General Hospitals","award":["VGHUST109-V2-2-1"],"award-info":[{"award-number":["VGHUST109-V2-2-1"]}]},{"name":"Veterans General Hospitals","award":["VGHUST109-V2-2-2"],"award-info":[{"award-number":["VGHUST109-V2-2-2"]}]},{"name":"Veterans General Hospitals","award":["VGHUST109-V2-2-3"],"award-info":[{"award-number":["VGHUST109-V2-2-3"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The convergence of asthma and air pollutants in ageing populations is currently a growing health issue worldwide, and hence there is an essential need to investigate the association between exposure to air pollution, particularly ozone (O<jats:sub>3<\/jats:sub>), and exacerbation requiring admission in patients with asthma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>A case-control study at a tertiary referral hospital in central Taiwan.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>We used an asthma cohort, which included 11\u2009400 patients with asthma, for the period 2006\u20132018 at Taichung Veterans General Hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Primary and secondary outcome measures<\/jats:title><jats:p>We identified patients who had admitted for exacerbation as cases and selected patients with asthma without exacerbation, matching (1:4) the cases for age, gender and season of exacerbation, as controls. Data on hourly level of air pollutants were obtained from the Taiwan Environmental Protection Administration. We used conditional logistic regression and calculated adjusted ORs (adjORs) with 95% CIs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We enrolled 11\u2009400 participants with asthma, and 4.4% (501) of them had been admitted for exacerbation. Participants with asthma with exacerbation requiring hospitalisation were exposed to a higher level of O<jats:sub>3<\/jats:sub> 8-hour daily maximum (adjOR 1.009, 95% CI 1.001 to 1.016) and were more likely to have high Charlson Comorbidity Index (CCI \u22653; adjOR 2.198, 95% CI 1.729 to 2.794) and asthma-chronic obstructive pulmonary disease overlap (adjOR 4.542, 95% CI 3.376 to 6.611) compared with those without exacerbation. The aforementioned associations between exacerbation of asthma requiring hospitalisation and exposure to O<jats:sub>3<\/jats:sub> were similar when defined by either O<jats:sub>3<\/jats:sub> 1-hour daily maximum or O<jats:sub>3<\/jats:sub> 24-hour average. Moreover, the O<jats:sub>3<\/jats:sub> relevant exacerbation of asthma mainly existed in those aged older than 65 years and patients with medical comorbidities, including gastrointestinal diseases, cardiovascular diseases, neurological diseases, diabetes and renal disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our findings highlight the need for vigilance of exposure to O<jats:sub>3<\/jats:sub> among elderly with asthma, particularly those with medical comorbidities. Further studies are warranted to investigate the underlying mechanisms.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2021-050861","type":"journal-article","created":{"date-parts":[[2022,2,15]],"date-time":"2022-02-15T03:18:31Z","timestamp":1644895111000},"page":"e050861","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Relationship between exposure to ozone and exacerbation requiring hospital admission among patients with asthma: a case-control study in central Taiwan"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2450-6108","authenticated-orcid":false,"given":"Ching-Heng","family":"Lin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li-Ting","family":"Wong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeng-Yuan","family":"Hsu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9631-8934","authenticated-orcid":false,"given":"Wen-Cheng","family":"Chao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,2,14]]},"reference":[{"key":"2022032701354341000_12.2.e050861.1"},{"key":"2022032701354341000_12.2.e050861.2","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-017-0409-3"},{"key":"2022032701354341000_12.2.e050861.3","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1159\/000081434","article-title":"Environmental influences on asthma and allergy","volume":"84","author":"Asher","year":"2004","journal-title":"Chem Immunol Allergy"},{"key":"2022032701354341000_12.2.e050861.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60617-6"},{"key":"2022032701354341000_12.2.e050861.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2017.10.018"},{"key":"2022032701354341000_12.2.e050861.6","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.0901220"},{"key":"2022032701354341000_12.2.e050861.7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1702747"},{"key":"2022032701354341000_12.2.e050861.8","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m108"},{"key":"2022032701354341000_12.2.e050861.9","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s40733-017-0034-1","article-title":"Ambient ozone and asthma hospital admissions in Texas: a time-series analysis","volume":"3","author":"Goodman","year":"2017","journal-title":"Asthma Res Pract"},{"key":"2022032701354341000_12.2.e050861.10","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1289\/ehp.1306940","article-title":"Influence of urbanicity and County characteristics on the association between ozone and asthma emergency department visits in North Carolina","volume":"122","author":"Sacks","year":"2014","journal-title":"Environ Health Perspect"},{"key":"2022032701354341000_12.2.e050861.11","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200908-1201OC"},{"key":"2022032701354341000_12.2.e050861.12","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1007\/s00704-020-03415-w","article-title":"Estimate the effects of environmental determining factors on childhood asthma hospital admissions in Lisbon, Portugal: a time series modelling study","volume":"143","author":"Rodrigues","year":"2021","journal-title":"Theoretical and Applied Climatology"},{"key":"2022032701354341000_12.2.e050861.13","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1186\/1476-069X-13-58","article-title":"Using community level strategies to reduce asthma attacks triggered by outdoor air pollution: a case crossover analysis","volume":"13","author":"Raun","year":"2014","journal-title":"Environ Health"},{"key":"2022032701354341000_12.2.e050861.14","doi-asserted-by":"crossref","DOI":"10.1016\/j.envint.2021.106435","article-title":"Short-term exposure to ozone, nitrogen dioxide, and sulphur dioxide and emergency department visits and hospital admissions due to asthma: a systematic review and meta-analysis","volume":"150","author":"Zheng","year":"2021","journal-title":"Environ Int"},{"key":"2022032701354341000_12.2.e050861.15","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)61087-2"},{"key":"2022032701354341000_12.2.e050861.16","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(92)90133-8"},{"key":"2022032701354341000_12.2.e050861.17","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1097\/MCP.0000000000000649","article-title":"Asthma-COPD overlap: review of diagnosis and management","volume":"26","author":"Venkata","year":"2020","journal-title":"Curr Opin Pulm Med"},{"key":"2022032701354341000_12.2.e050861.18","unstructured":"Taiwan Air Quality Monitoring Net work . 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